INTERFACEBoulder Colorado

Sandy McCarthyJudy DettmerKevin Pettit

Colorado Traumatic Brain Injury Trust Fund Program

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Program Overview

Passed into Law in 2002Title 26, Article 1, Part 3, Colorado Revised Statutes

Created TBI Trust fundAdded surcharges to traffic offensesCreated TBI BoardDesignated allocation of fundsPlaced in Department of Human Services

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Surcharges

$15 for each conviction of driving under the influence (DUI), or driving while ability impaired (DWAI)$10 for each conviction of speedingSurcharges began January 2004Generated over $4 million in first 2.5 years

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TBI Board

13 members3 members designated in statute10 members appointed by the Governor with the consent of the Senate

Diverse group of people with expertise in TBI, including medical providers, health care professionals, survivors and family members, researchers, and State officialsRole is to oversee the operations of the Trust Fund

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Allocation of Funds

65% to provide services to individuals with TBI30% to support research related to the treatment and understanding of TBI5% to provide TBI education for survivors, family members, professionals, educators, and others in the community

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Role of Department of Human Services

Financial managementPolicy developmentProgram development and implementationContract managementProgram monitoringAdministrative supportWebsite maintenancePublic assistance and informationReportingPublic relations

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Client Services Overview

TBI DefinitionEligibility CriteriaCare CoordinationPurchased ServicesIntake and Eligibility ProcessChildren’s ServicesAdult ServicesLimitationsWait List

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TBI Definition

Statute – Injury to the brain caused by physical trauma resulting from but not limited to incidents involving motor vehicles, sporting events, falls, and physical assaults.

TBI Board – Damage to the brain caused by external physical force, including acceleration / deceleration injuries. This does NOT include brain injury caused by a congenital causation, degenerative diseases, surgical interventions or anoxia.

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Eligibility Criteria

Colorado resident & proof of legal presence in U.S.Documentation of a TBI that is sufficient in severity to produce a partial or total disability as a result of impaired cognitive ability and/or physical functioningNo other health or rehabilitation benefit funding sources that cover the services provided by the Trust FundDo NOT have to exhaust private funds

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Care Coordination

All individuals receive Care Coordination services

Assigned care coordinatorDevelop care coordination planIdentify individual needsApply for benefitsAccess existing benefitsFind resources in the communityCoordinate services from different service providersArrange for services through Trust Fund

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Purchased Services

May purchase services including but not limited to:

Community residential servicesStructured day program servicesPsychological and mental health servicesPrevocational servicesSupported employmentCompanion services

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Purchased Services (continued)

Respite careOccupational therapySpeech and language therapyCognitive rehabilitationPhysical rehabilitationOne-time home modificationMany other services that are appropriate for individuals with TBI

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Excluded Services

Institutionalization

Hospitalization

Medications

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Intake and Eligibility Process

Brain Injury Association of Colorado performs client intake and eligibility

Assist individuals with the application processDetermine eligibilityRefer eligible individuals for Trust Fund services

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Children’s Services

Denver Options, Inc. and the Colorado Department of Public Health and Environment, Health Care Program (HCP) for Children with Special Needs provide children’s services

Under age 21Care coordination provided through 14 local health departments around the statePurchase services from service providers throughout the state

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Adult Services

Denver Options, Inc. provides adult services

Age 21 and olderCare coordination provided by Denver Options staff and some contracted care coordinators Purchase services from service providers throughout the state

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Limitations on Services

Limited resourcesProgram intended to fill gaps, not designed or funded to be the individual’s primary source of servicesNot an entitlement program (like Medicaid)Services are subject to available fundingFirst come, first servedIndividuals may receive funds for services for 1 year

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Limitations on Services (continued)

May re-apply to receive another year of care coordination but will go to end of wait list if program is at capacity $2,000 life time limit for purchased servicesPurchased services must be included in Care Coordination Plan and approved in advanceTrust Fund does not pay clients directly

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Research Program

TBI Board awards research grants annuallyInitial grants funded at $50,000 per yearIn 2007 research program was changed to fund 3 levels of grants at $50,000, $250,000 and limitless for level three grantsResearch priorities related to Basic Science, Clinical Science, and Health Services and OutcomesAnnual application and review processHave awarded a total of 16 research grants

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Education Program

Program brochure in English and SpanishWebsite: www.tbicolorado.orgPresentations and exhibit table at conferencesEducation Grants: a total of 46 grants have been awarded

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Additional Information

Brain Injury Association of Colorado4200 West Conejos Place, Suite 524Denver, CO 80204888-331-3311 – toll freewww.biacolorado.org

Department of Human ServicesOffice of Behavioral Health and Housing3520 West Oxford AvenueDenver, CO 80236303-866-7477www.tbicolorado.org

Clinical Intervention

Things to Keep in Mind

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GREIVING AS IT RELATES TO GREIVING AS IT RELATES TO BRIAN INJURYBRIAN INJURY

Brain injury affects all aspects of a persons life(often not the same person anymore)

Grieving is an on-going process and may be heightened at times of transition

Can not rush the grieving process

Recognize when grieving is occurring and provide support as needed

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POTENTIAL BARRIERS TO POTENTIAL BARRIERS TO CLINICAL INTERVENTIONCLINICAL INTERVENTION

Short term memory loss

Attention and concentration

Organizational ability

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POTENTIAL BARRIERS TO POTENTIAL BARRIERS TO CLINICAL INTERVENTIONCLINICAL INTERVENTION

Fatigue

Lack of inhibition

Lack of awareness/insight

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STRATEGIES FOR STRATEGIES FOR ADDRESSING ADDRESSING MEMORY ISSUESMEMORY ISSUES

Encourage the individual to write information down or tape record it

Encourage individual to use as many environmental aides as possible (labeling items, shelves, using bulletin boards etc.)

Give brief and concise instructions

Encourage the individual to ask for instructions repeated as needed

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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING CONCENTRATON/ATTENTION ISSUESCONCENTRATON/ATTENTION ISSUES

Provide the individual with an uncluttered environment

Eliminate as many auditory and visual distractions as possible

Eliminate as many interruptions as possible

Allow the individual to work on one task at a time

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Organizational/Planning Skills Strategies

Do not assume that the individual has the ability to take responsibility for the organizational aspects of his/her program

Understand that it will take an individual with a brain injury longer to learn routines and understand what is expected of them

Provide individual with a day timer and calendar to assist with memory and organization

Assist the individual in using the day timer and calendar until this becomes routine

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Organizational/Planning Skills Strategies

Routines are critical to minimize the need to initiate tasks

Individual may need support to see a task through to completion until the task is routine

Reminder calls may be necessary to ensure follow through when the individual is engaging in an unfamiliar task

Prepare the individual for transitions and disruptions to their routines

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STRATEGIES FOR ADDRESSINGSTRATEGIES FOR ADDRESSINGFATIGUE ISSUESFATIGUE ISSUES

Encourage the individuals to take rest breaks, may have to schedule breaks until individual can begin to recognize when they need a break

Be aware that medications an individual is taking may make them fatigued

If individual is overloaded or fatigued do not keep pushing

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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO DISINHIBITIONISSUES RELATED TO DISINHIBITION

Gently provide feedback regarding an individual’s behavior at the time the behavior occurs

Video taping (with the individual’s consent)

When possible, ensure the participant is not in an environment that could cause him/her difficulties

Role playing consistently and repeatedly may be helpful

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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO DISINHIBITIONISSUES RELATED TO DISINHIBITION

Need to be concrete and consistent when providing feedback e.g. do not talk to a woman about her looks

The individual may benefit from attending a support group for individuals with brain injury

When dealing with employment, be up-front with the employer so that they are not caught off guard but rather are proactive and supportive

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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO ISSUES RELATED TO

AWARENESSAWARENESSBuilding a new identity following brain injury takes time

Provide individual opportunities to try different activities in a safe environment (work, community and home related)

Provide feedback on an on-going basis

Video tape the individual (with their consent)

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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO ISSUES RELATED TO

AWARENESSAWARENESS

Do not assume the person in “denial”

Professional counseling may be beneficial

Allow time for grieving

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KEY ELEMENTS FOR SUCCESSFUL KEY ELEMENTS FOR SUCCESSFUL CLINICAL INTERVENTIONCLINICAL INTERVENTION

The participant is in charge

Skills often do not transfer, train the individual in the environment they are expected to perform the task

Be consistent when teaching strategies and allow for sufficient time for them to become routine

Understand that grieving and creating a new identity takes time

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TBI and Substance Abuse67% of individuals in a rehabilitation program for TBI have a history of substance abuse prior to injury

Individuals with TBI test positive for alcohol in 2/3 of motor vehicle crashes

Approximately 20% of persons who did not have substance abuse problems prior to TBI are vulnerable after TBI

Corrigan

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Five Stages of Change

1. Precontemplation2. Contemplation3. Preparation4. Action5. Maintenance

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Stages of Change and TBI

Limited self awareness will affect ability to work through stages

Need to assess individuals ability to self reflect

May not be able to independently implement coping strategies

Repeated practice with strategies will help individual become more independent

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Mental Health and TBI

Depression

Anxiety

Personality Changes

Aggression

Social Inappropriateness

NAMI

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Effective Treatment Approaches

Not much research

Clinicians feel that techniques found effective for people in general can also be effective for individuals with TBI

However, special considerations or accommodations may be required

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Specific Interventions

Motivational Interventions

Cognitive-Behavioral Therapy

Therapeutic Community